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Respiratory Medicine Exam I > Respiratory Infections & Tumors > Flashcards

Respiratory Infections & Tumors Flashcards

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1
Q

How can pulmonary infections be classified by anatomic distribution?

A

Bronchopneumonia — patchy infiltrate

Lobar pneumonia — diffusely affecting one specific lung lobe

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2
Q

4 Stages of lobar pneumonia and associated pathologic changes

A
  1. Congestion: vascular engorgement
  2. Red hepatization: red cells and inflammation
  3. Grey hepatization: inflammation and debris
  4. Resolution: fibrosis, macrophage clean-up
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3
Q

3 primary complications of lobar pneumonia

A

Abscess
Empyema
Bacteremia

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4
Q

What is the difference between an abscess and an empyema?

A

Abscess destroys surrounding area and fills with inflammatory fluid

Empyema is when inflammatory fluid builds up in pre-existing anatomic space

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5
Q

Bacterial causes of community-acquired pneumonia

A 
S.pneumoniae
H.influenzae
S.aureus
K.pneumoniae
P.aeruginosa
L.pneumophila
M.pneumoniae
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6
Q

Most common cause of community acquired pneumonia

A

Streptococcus pneumoniae (aka “pneumococcus”)

[although incidence is decreasing due to vaccination in older adults, children, and smokers]

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7
Q

Characteristic histology of streptococcus pneumoniae

A

Lancet-shaped gram positive diplococci in pairs and chains

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8
Q

______ _____ is a virulent pneumonia in children, and vaccination is recommended for type B (most virulent strain) in kids <5 y/o

A

Haemophilus influenzae

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9
Q

Bacteria causing pneumonia that is associated with abscess formation and IV drug use

A

Staphylococcus aureus (usually MRSA)

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10
Q

Bacteria causing pneumonia, often associated with currant jelly sputum and alcoholism

A

Klebsiella pneumoniae

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11
Q

What type of organism is typically implicated in pts who have community-acquired pneumonia in the setting of cystic fibrosis?

A

Pseudomonas aeruginosa

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12
Q

Gram-negative bacillus that grows in warm freshwater with airborne transmission, causes community acquired bacterial pneumonia

A

Legionella pneumophila

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13
Q

Viral causes of community-acquired pneumonia

A

Influenza (H1N1)
SARS
RSV

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14
Q

Influenza virus is classified by what 2 proteins?

A

Hemagglutinin — attachment to cells

Neuraminidase — release of replicated virus from cells

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15
Q

Signs/symptoms of influenza

A 
Abrupt symptom onset
Fever (lasts 3-4 days)
Severe aches
Chills
Fatigue, weakness
Headache also common

[contrast with common cold which has gradual onset, fever and chills rare, milder aches, hadache is rare]

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16
Q

Differentiate antigenic drift from antigenic shift

A

Antigenic drift:
Associated with epidemics; MINOR changes to proteins (Ags) on the virus, allowsing increased spread. Similar enough to original virus to allow for some immunity in many individuals

Antigenic shift:
Associated with pandemics; genomic changes with MAJOR resulting changes to protein structure. Naive immunity for almost all people

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17
Q

What type of virus causes severe acute respiratory syndrome (SARS)?

A

Coronavirus

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18
Q

Neonatal bacterial causes of pneumonia

A

Group B strep, gram-negative bacilli, listeria

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19
Q

Viral causes of pneumonia in children >1 month

A 
Respiratory syncytial virus
Parainfluenza virus
Influenza A and B
Adenovirus
Rhinovirus
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20
Q

Bacterial causes of pneumonia in children >1 month

A

S.pneumoniae
H.influenzae
M.catarralis
S.aureus

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21
Q

Causes of pneumonia in older children/adolescents are similar to those in younger children, with less likelihood of ________ virus.

Additional bacterial considerations in older children include ______ and _______

A

respiratory syncytial

M.pneumoniae
C.pneumoniae

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22
Q

What type of virus is RSV and what are some clinical features?

A

Paramyxovirus

Symptoms of rhinorrhea, cough, wheezing, dyspnea, tachypnea, cyanosis

[generation of mucus in airways is what leads to difficulty breathing]

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23
Q

Other than RSV, what are some paramyxoviridae with effects on respiratory system?

A

Human metapneumovirus (hMPV)

Parainfluenza

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24
Q

What is the major difference between bacterial vs. viral pneumonia on histology?

A

Bacterial pneumonia shows infiltrate in alveolar spaces

Viral pneumonia shows infiltrate in interstitium

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25
Describe bacterial pneumonia in terms of onset, association with epidemics and/or sepsis, fever, lung exam findings, CXR findings, pleural involvement, and treatment
Abrupt onset Not associated with epidemics (exceptions: legionella, pertussis) May have associated bacteremia High grade fever Crackles on lung exam Lobar or consolidated appearance May involve pleura Responds quickly to appropriate antibiotics
26
Describe viral pneumonia in terms of onset, association with epidemics and/or sepsis, fever, lung exam findings, CXR findings, pleural involvement, and treatment
Gradual onset Epidemics are common Not typically associated with viremia No fever or low grade fevers Wheezes on lung exam Diffuse infiltrates on CXR Will not typically involve pleura Will not respond to antibiotics but tend to be self-limiting
27
Lung abscess is a complication of pneumonia often associated with what 2 bacterial causes?
S.aureus | K.pneumoniae
28
Aspiration leading to lung abscess is often associated with what patient population?
Chronic alcoholics
29
How does the course of TB infection change in immunocompetent vs. immunocompromised hosts?
In immunocompetent patients, the primary infection usually resolves into latent/dormant pulmonary lesion that may reactivate to become the more aggressive secondary/miliary TB in the setting of changes in the immune system later (like if pt contracts HIV, develops RA, etc.) In a patient that is already immunocompromised, the primary infection is more likely to progress to miliary TB directly after primary infection
30
Characteristic histologic and gross findings of TB
Histology: caseating granulomas (infiltrate consisting of histiocytes, multinucleated giant cells, neutrophils) Gross: Ghon complex
31
Fungus endemic in midwest and Caribbean (Ohio and Mississippi river valleys), typically causing subclinical infection with granulomatous response (calcifications or coin lesions on CXR) with characteristic yeast forms showing “pumpkin seed” morphology; can run aggressive course, especially in immunocompromised patients
Histoplasma capsulatum
32
Fungus endemic in central and SE US (ohio and mississippi river valleys) that causes granulomatous response in the lungs with characteristic yeast forms that show broad-based budding; can also infect skin and rarely disseminated infection
Blastomyces dermatitides
33
Fungus endemic in SW US and Mexico, causing granulomatous response with eosinophils in the lungs; often subclinical and self-limited disease but can produce disseminated infection especially in immunocompromised pts
Coccidioides immitis
34
Causes of pneumonia with diffuse infiltrates in immunocompromised pts
Common: CMV Pneumocystis jiroveci Drug reaction ``` Uncommon: Bacterial pneumonia Aspergillus Cryptococcus Malignancy ```
35
Causes of pneumonia with focal infiltrates in immunocompromised pts
``` Common: Gram-negative bacterial infections Staphylococcus aureus Aspergillus Candida Malignancy ``` ``` Uncommon: Cryptococcus Mucor Pneumocystis jiroveci Legionella pneumophila ```
36
Opportunistic fungal infection and AIDS-defining illness with characteristic cup-shaped yeast forms on histology, and that can present in many ways radiographically
Pneumocystis jiroveci (carinii)
37
Infection in immunocompromised or elderly patients characterized as AIDS-defining illness and displays as thin mycobacteria seen as slender red forms on acid-fast staining
Mycobacterium avium complex (MAC)
38
After a lung transplant, what test is required to differentiate lung infection from rejection, which both cause infiltrates and fever? Why is it important to distinguish between the two in terms of management?
Biopsy is needed to discriminate between the two Rejection shows mononuclear infiltrates around vessels, and management requires an increase in immunosuppression therapy With acute infection, you do NOT increase immunosuppression because their condition will worsen
39
Leading cause of cancer deaths in males vs. females
Leading cause is lung and bronchus cancer in both males and females [second leading in estimated new cases for both males and females as well]
40
Epidemiology and risk factors for lung and bronchial cancer in terms of smoking
Tobacco use in terms of duration AND intensity (note pack years) Carcinogen exposure may be mitigated by genetic variation in patients (P450 polymorphisms and genes responsible for DNA repair)
41
3 basic classifications of lung tumors
Adenocarcinoma (38%) Squamous cell carcinoma (20%) Small cell carcinoma (14%)
42
How would you characterize dysplastic pneumocytes present along alveoli with some interstitial fibrosis and is <5 mm?
Atypical adenomatous hyperplasia (AAH)
43
How would you characterize dysplastic pneumocytes confluently growing along alveoli and is <3 cm?
Adenocarcinoma in situ (AIS) [formerly bronchioloalveolar carcinoma (BAC)]
44
Most common lung malignancy in smokers and non-smokers
Pulmonary adenocarcinoma
45
T/F: pulmonary adenocarcinoma can arise from precursors or develop de novo. There are many variants so it is important to distinguish between them for tx purposes
True
46
The most important histologic feature of pulmonary adenocarcinoma is malignant ____ invading the lung tissue
Glands
47
What is unique about mucinous adenocarcinoma in terms of spread?
Spreads via respiration/air movement throughout the lungs — so it can mimic pneumonia on CXR
48
Progression of squamous carcinoma
Normal bronchial epithelium Squamous metaplasia Squamous carcinoma in situ Invasive squamous carcinoma
49
Squamous carcinoma is more common in _____, has a strong association with _____, and often occurs in _____ location
Men; smoking; central
50
Squamous carcinoma may be recognized on histology by presence of ______ _____ and/or ______ _____ On cytology, _____ may show up as orange cytoplasm
Keratin pearls; intercellular bridges Keratin
51
Small cell neuroendocrine carcinoma is almost always associated with _____ and has a _____ rate of metastasis
Smoking; high
52
Histologic features of small cell neuroendocrine carcinoma
Small cells with fine blue nuclear chromatin, scant cytoplasm, and characteristic pattern of necrosis
53
Why is it important to identify small cell neuroendocrine carcinoma for tx purposes?
Surgical excision is not recommended if metastasized to LNs Specific chemotherapy available for different types Chemo/radiation is effective in most cases but there is a high rate of recurrence
54
Paraneoplastic syndrome associated with squamous carcinoma
Hypercalcemia (PTH-related peptide)
55
Paraneoplastic syndromes associated with small cell carcinoma
SIADH | Cushing’s syndrome (secretion of ACTH)
56
Paraneoplastic syndrome characterized by enophthalmos, ptosis, miosis, and anhidrosis
Horner’s syndrome
57
“Precursor lesion” of neuroendocrine tumors
Diffuse interstitial pulmonary neuroendocrine cell hyperplasia (DIPNECH)
58
DIPNECH nodules may be detected by high-resolution CT scan. What are the size restrictions to be characterized as DIPNECH?
Very small, less than 5mm (still considered hyperplasia!)
59
How is DIPNECH distinguished from a carcinoid tumor?
Based on size and ability to metastasize DIPNECH are less than 5mm and do not have potential to metastasize at this point Carcinoid tumors are 5mm or larger and have potential to metastasize (although indolent course) — considered neuroendocrine carcinoma grade 1
60
Atypical carcinoid tumors are considered neuroendocrine tumor grade 2. What are some differences between this type and grade 1?
Grade 2 have increased mitotic activity, necrosis, and disordered growth Increased rate of metastasis and lower survival as well (although still better prognosis than small cell carcinoma)
61
Features of carcinoid syndrome
Flushing, diarrhea, cyanosis (presents similarly to GI carcinoid syndromes)
62
Disordered growth of tissues normally found in the organ that it is growing in; lung example histology shows firm “marble” with smooth edges, fibrous tissue with benign glandular epithelium around hyaline cartilage
Hamartoma
63
Respiratory pathology typically affecting young women, characterized by proliferation of modified smooth muscle cells, positive for melanoma markers like HMB-45, in addition to perivascular epithilioid cells creating cystic spaces, and may present with penumothorax
Lymphangioleiomyomatosis (LAM)
64
Genetic association with lymphangioleiomyomatosis
Loss of function of tumor suppressor TSC2
65
Major causes of pleural effusion — if it is transudate
Heart failure (increased hydrostatic pressure; “overflow” of liquid from the lung interstitium) Nephrotic syndrome (decreased plasma oncotic pressure) Cirrhosis (movement of transudative ascitic fluid through the diaphragm)
66
Major causes of pleural effusion — if it is exudate
Inflammatory conditions — infection, PE, CT disease (lupus, RA), adjacent to subdiaphragmatic disease (pancreatitis, subphrenic, subphrenic abscess) Malignancy
67
How might pleural effusion present grossly in pt with malignancy vs. lymphatic obstruction vs. heart failure?
Malignancy - bloody effusion Lymphatic obstruction - milky chylous effusion Heart failure - serous transudative effusion
68
Inflammatory exudate with accumulation of pus in the pleural space typically d/t bacterial infection, notorious for creating loculations (web-like traps for fluid); fluid will be thick, yellow with smears of fluid showing neutrophils and often bacteria
Empyema
69
Primary (lung) causes of pneumothorax
Rupture of subpleural blebs (usually young patients)
70
Secondary causes of pneumothorax
``` Cystic infections (PCP) Cystic tumors Rupture of subpleural blebs Positive-pressure ventilation Trauma ```
71
What causes tension pneumothorax?
Injury to the chest wall, resulting in one-way valve allowing air into the pleural space, but not out [it is the expansion of the chest wall that is responsible for inspiration, and air will be pulled in from wherever it is easiest. In a closed system, air is a space-occupying lesion
72
Compare primary vs. tension pneumothorax in terms of pressure in the pleural cavity
Primary: pleural cavity pressure is less than atmospheric pressure Tension: pleural cavity pressure is greater than the atmospheric pressure
73
Malignancy associated with asbestos exposure, and may occur decades after the exposure (lifetime exposure risk is as high as 10%)
Mesothelioma
74
Ferruginous bodies on histological exam are manifestations of _______, which in worst case scenarios may progress to mesothelioma
Asbestosis
75
Variants of mesothelioma
Epithelioid Sarcomatoid Mixed
76
Special stains like ______ help distinguish mesothelioma from adenocarcinoma
Calretinin
77
Prognosis for mesothelioma
Difficult to treat — cannot be easily excised, limited responsiveness to chemotherapy and radiation Most patients will not live 2 years after diagnosis, even in early stage disease

Respiratory Medicine Exam I (9 decks)

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